Wiki Hospitalist and Modifier 25

[katcoder]

My hospitalist and general surgeon are in same practice but have different specialties. On the same day the general surgeon performs surgery, my hospitalist does a consult on the patient for hypertension, diabetes, and hypokalemia….then sees the patient two more times during his in-patient stay. I know I don't need a modifier on 99232, but wouldn't I put a modifier 25 on the 99253?

99253/25 IP Consultation
99232 Subsequent Visit
99232 Subsequent Visit

Thanks everyone for your help!!

 

[CBaer]

Hospitalist

My hospitalist and general surgeon are in same practice but have different specialties. On the same day the general surgeon performs surgery, my hospitalist does a consult on the patient for hypertension, diabetes, and hypokalemia….then sees the patient two more times during his in-patient stay. I know I don't need a modifier on 99232, but wouldn't I put a modifier 25 on the 99253?

99253/25 IP Consultation
99232 Subsequent Visit
99232 Subsequent Visit

Thanks everyone for your help!!

No, if they are different specialties no modifier is needed. However, if the hospitalist is an NPP and you recieve a denial from Medicare this would be because Medicare does not link a specialty to the NPPs. You will need to show that the NPP is working in a different specialty. This can be done by appealing and submitting documentation that shows that the NPP is working as an Internal Medicine or General Medicine and/or who the NPP supervising physician is and his/her specialty.

Modifier 25 would be used only if the hospitalist performed an EM and another service or a minor procedure (10 global days or less) on the sameday.

 

[katcoder]

Thanks!